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Needlestick Trauma! YOUR ADVICE PLEASE!!!!
Aug 6, 2002

Dearest Dr. Bob,

You are a saintly man indeed! Your care, incessant compassion, reassuring personality, warmth, character, and integrity is beautiful! Your words bring faith to us here in the body who need it the most. We know that without you here doing the job that you provide with your answers, we all would be at a loss. I really need your advice Dr. Bob. May I call you Bob? I feel like you are a very good friend to me. Well, i had the unfortunate accident with a needle back in March, March 18 to be exact. What followed then leads me to believe that i may be fearing what is. Let me explain. Three days after the incident, my throat started to burn, got sore in feeling and i believe it lasted for this like for a good three weeks. In fact it got so bad I got Zithromax prescribed to me. But it really didn't help my throat. Rather now my tongue has turned completely white since then and i cant seem to scrape off the whiteness now matter how much i brush my tongue. I think it is thrush. There always is a streak whether in the middle of the tongue going down from the back to the front and or on the sides. What is worse, is that i got stuffed up right after the incident and i still feel stuffy to this day. I have constant mucus coming out of my nose and phlegm coming onto my tongue from the back of my throat. Even worse, I have developed these red marks on my skin, definitely not pimples about 10 on my upper torso and some on my arms and a few on my back. Never were there before this accident. I am very fatigued since that date but i have worried myself sick to death. I am so nervous that I cant sleep or eat even. Sometimes i have watery stools right after i eat. It literally feels like if i ate 20 pumpkin pies and they are pumping themselves immediately out of my behind, no joke! Am I incorrect, that these are "cornerstone markers" of symptoms for hiv infection! Now Bob I was so convinced that i have HIV infection that i went 36 days after this exposure and got a DNA PCR test through Specialized Anonymous testing, came back negative. I was not convinced at all, not that i dont want this result to be true so help me god. I just dont want to be told later on something different. So i want again at 57 days and took another DNA PCR through Specialized Testing, negative again! I feel like Nathan Lane in the Birdcage, i just cant seem to win at times! What should i do? I spoke with a couple of doctor friends i have and explained to them my situation, they told me that it could be sinusitis or something. But doctor can this be true? I have decided to wait out till September 18 (6 months) to get tested but i wonder if i am making the right choice? What would you do? I just dont feel like going to get blood drawn every ten days. I still feel stuffy and am run down like hell. Should i get a HIV antibody type one and type 2 test? Must i get a RNA PCR test to rule out infection if by some miracle the antibody test comes out negative? Or should it be DNA PCR? Can i trust these results, or must i retest at 12 months if negative? What about the two dna pcrs, are they totally pointless at this point in time. Bob dearest Bob I admitt I am at a loss without your wisdom here. I feel even the doctors i know may not want to tell me what may be. Please let me have it your way! God bless and stay well forever! Long Health and Life!

With Love,

Insecure and Currently Constipated Law Student

Response from Dr. Frascino

Hello Insecure and Currently Constipated Law Student!

Thank you for your flattering comments. You lawyer guys really know how to turn on the sweet talk now, don't you? Promise me you won't be an ambulance chaser or "contingency only" medical malpractice lawyer, and I'll answer your questions, OK?

As Perry Mason would say, "Let's review the facts." (By the way, Perry Mason was a popular, good-hearted lawyer on T.V. many, many years ago, long before L.A. Law or Alley McBeal). "Cornerstone Markers" for HIV infection? Absolutely not! Thrush, a fungal infection on the mucous membranes of the mouth, can indicate a suppressed or deficient immune system. However, it can also occur after antibiotics, such as Zithromax, which kills off normal bacteria and allow normal fungi to overgrow, causing the symptoms called thrush. More importantly, your symptoms do not sound like thrush, which is quite easily scraped or brushed off the tongue and mucous membranes. So, what you "think is thrush" is not! Next, being "stuffed up and having constant mucous coming out of your nose and phlegm coming onto your tongue from the back of your throat" may be annoying and distasteful, but it is not a sign of HIV or a seroconversion-type reaction. Far from a "cornerstone," it isn't even a crumbling old brick! Your doctor friends are probably correct. It sounds a lot like a head cold, sinusitis, or perhaps allergies. Have your doctor or an "ear, nose and throat" specialist take a look. This should be quite easily cleared up with proper diagnosis and treatment.

Next, the red marks on your skin do not in any way resemble the rashes associated with HIV seroconversion, so that knocks that out of consideration as well. What's causing the red marks? I really can't tell without seeing them. No, don't send photos. See a dermatologist, as these are bothering you.

Now, the watery stools after you eat. First of all, how do you know what it would feel like to pump 20 pumpkin pies out your behind? No, the pumpkin pie power pump is also not indicative of HIV. Next, the "so nervous that you can't sleep or eat" and the "fatigued" symptoms are probably intimately related. That's just simple cause and effect deductive reasoning and again not related to HIV. So the verdict, my dear friend, is right there in your deposition . . . errr . . . I mean your question! "I have worried myself sick!" That's the only logical answer, and all the facts point to that conclusion.

Now, let's look at the hard physical evidence. Your HIV tests (DNA PCR) were negative at 3y days and 57 days. That's very hard evidence we are not dealing with HIV! What tests should you take? The best screening test would be an HIV antibody test (ELISA) at 6 months. Based on all the information and physical evidence (lab tests), you will be negative. There is absolutely no need for additional DNA or RNA PCRs or to retest at 12 months. Are your 2 negative DNA PCRs pointless? Absolutely not! They are very, very encouraging.

As for other doctors' not wanting to tell you what may be, I strongly doubt that. Medicine and law are very, very different professions. You guys need to keep information sec ret and spin the facts to your advantage to win cases, even when the evidence is overwhelmingly contradictory (for instance, O.J.!). Physicians, on the other hand, have absolutely no vested interest in getting you to believe something that is untrue, which might delay or alter your treatment to your detriment.

The jury is in, and the verdict is unanimous. You are not HIV infected. Go ahead and get your 6-month HIV ELISA, if you want. It will be negative. Finally, rather than law school, would you rather try medical school?

Don't be like Nathan Lane in "Birdcage." Be like Gregory Peck in "To Kill a Mockingbird."

Stay well! This case is dismissed!

Dr. Bob


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